When are you most sensitive to malformations during pregnancy?
18-60 days
Doses of drugs and teratogenic impact
- the higher the dose, the higher the risk to the fetus
- some drugs have a threshold of theratogenicity
types of teratogenicity
- alterations in fertility
- gene mutations or chromosomal breaks in egg/sperm
- pregnancy loss
- birth defects
- fetal growth retardation
- alterations in intellect or behavior
- carcinogenicity
confounding factors and teratogens
- poor prenatal care
- maternal nutrition
- maternal illness
- polytherapy
inheritance of addiction
- biological reason poorly understood
- many studies observed that it runs in family
- may be addiction genes or related to depression, bipolar or ADHD
almost ____ % of american women are abstinent from alcohol
40
________ children are born with fetal alcohol syndrome in US each year.
4000
- completely preventable
who is at risk for fetal alcohol syndrome?
- teens
- indigent
- women with mental health issues
- certain ethnic groups
assessment for risk of drinking during pregnancy
- laboratory tests like urine toxicology
- questionnaires
4 Ps and alcohol and pregnancy
4 yes/no questions asked during patient’s current pregnancy, in her past, in her partner and in her parents
- one positive answer is any question to considered an overall positive screen for a risk drinker
NET alcohol and pregnancy
- do you consider yourself a normal drinker?
- do you ever have an eye-opener?
- how many drinks does it take to make you feel high?
Tobacco and increased risk during pregnancy
- intrauterine growth retardation
- prematurity
- stillbirth
- facial clefts
- learning disorders
- hyperactivity
Breastmilk and tobacco
amounts proportional to number of maternal cigarettes
What is postnatal exposure to tobacco associated with?
SIDS
asthma
ear infections
Smoking cessation not recommended in pregnancy
- varencline
- nicotine vaccine
E-cigs
- heated nicotine
- may include pot
- avoids exposure to carcinogens
- varying evidence to pregnancy
Alcohol and pregnancy
- pregnancy loss
- fetal alcohol syndrome
Fetal alcohol syndrome
- growth retardation
- CNS dysfunction
- characteristic facial features
- malformations
Binge drinking and pregnancy
- may be as risky as daily use of moderate amounts
breastmilk and alcohol
equal to maternal blood concentrations
- more than one drink a day may result in drowsiness, developmental delays
Facial characteristics of fetal alcohol syndrome
- flat philtrum
- thin upper lip
- microcephaly
- flat maxillary area
Pot and pregnancy
- minimal risk for birth defects
- some subtle behavioral changes
- chronic use in 3rd trimester may cause problems with newborn adaptation
- extorted in breast milk
cocaine and pregnancy
- obstetrical complications
- intrauterine growth
- small risk for malformations
- neonatal behavioral abnormalities disappear in first few months of life
- SIDs
cocaine and breastmilk
- vomiting
- tremulousness
- irritability
- seizures
